Type 2 diabetes is caused by eating too much sugar (candies, fruits, processed foods) starches (potatoes), and grains (breads, pastas, pastries), leading many to diabetes. Traditional diabetes treatment uses drugs, and at some point insulin injections. Do medications cure diabetes? No. Do they have dangerous side effects? Yes. Is the American Diabetes Association diet the best approach for diabetes? No. Can type 2 diabetes be put into remission without medications? Yes. After reading this you’ll have a better understanding why standard diabetes treatment has failed us.
This article will review the metabolic conditions that can precede diabetes or occur because of diabetes. We will review the types of medications used in its traditional treatment, the side effects often accompanying these medications, the economics of this disease, traditional diet recommendations, and the effectiveness of the traditional strategy. Since we know that failure from the traditional approach is inevitable, we’ll look at HEAL’s approach that at the least minimizes the need for drugs, controls blood sugar/glucose levels without diabetes medications, and helps one normalize weight.
Understanding the Basics
The first step on the road to diabetes is insulin resistance, meaning that certain cells can’t use insulin properly. The body tries to compensate by over producing insulin (hyperinsulinism), an attempt to control high blood sugar levels. If this process continues long enough, the beta cells in the pancreas that make insulin begin to fail. Ultimately insulin injections are needed.
Having above normal amounts of insulin increases fat storage especially in the belly, increases water retention and blood pressure, and causes inflammation of the arteries and veins. When this inflammation becomes chronic, it can damage all parts of the body, and plays a major role in causing many diseases including cardiovascular and circulatory disorders, neuropsychiatric disorders including Alzheimer’s, fatty liver, Polycystic Ovary Syndrome, cancers, osteoporosis, and inflammatory joint conditions.
Beyond insulin resistance and hyperinsulinism, other metabolic abnormalities occur playing a role in the pathology of a person with type 2 diabetes.
- Plasma fatty acid concentrations are increased causing fat cells to lose their ability to store enough fat. This leads to excess fat accumulations invading the liver, muscles, beta cells of the pancreas, and blood vessel walls.
- Improperly functioning fat cells produce unhealthy chemicals that lead to inflammation while being unable to produce the necessary chemicals that help regulate glucose and fatty acid utilization.
- Glucagon, a compensatory hormone produced by alpha cells in the pancreas, normally keeps the blood sugar from dropping too low. However, in people with diabetes, high glucagon levels may cause hyperglycemia, which left untreated, leads to serious complications requiring emergency care, such as a diabetic coma.
Complications of Diabetes
The complications of diabetes are many including:
- Diabetic retinopathy, the leading cause of blindness in adults and an increased likelihood of developing cataracts and glaucoma.
- Diabetic nephropathy, damage to the filtering mechanism in the kidneys, which can lead to kidney failure and end-stage kidney disease requiring dialysis or transplant. Diabetes is the most common cause of kidney failure in the US.
- Peripheral neuropathy and vascular damage leading to amputation and painful nerve damage in the hands and feet.
- Cardiovascular disease, strokes, and hypertension.
- Hearing impairment.
- Skin conditions such as bacterial or fungal infections.
- Overall diminished resistance to all infections accompanied by poor healing.
- Dementia and Alzheimer’s disease.
As discussed, there are a number of metabolic abnormalities that occur with type 2 diabetes. Standard therapy often targets these mechanisms with different drugs. Additionally, there are other conditions that often accompany diabetes and/or obesity that utilize drug therapy. They include GERD, hypertension, arthritis, depression and lipid disorders.
Consequently, people with diabetes are often victims of polypharmacy: administering multiple medications for a single condition or associated conditions. This is especially dangerous in the elderly. They are at risk because ageing livers may be unable to metabolize all the drugs, are more likely to have drug interactions, too many pills to take, are too expensive, difficult to organize and dose properly and risk significant side effects.
Commonly Prescribed Blood Sugar Drugs and Their Side Effects
- Sulfonylureas – older drugs that stimulate insulin secretion. They do not help to preserve beta cell function and stop working over time. Further, they do not protect the vascular system from complications. Brand names: Amaryl, Diabinese, Micronase, Glynase, DiaBeta, Glucotrol. Prandin and Starlix are newer versions. Side effects include weight gain, hunger and hypoglycemia.
- TZDs – decreases insulin resistance, hepatic insulin sensitizer, and decreass lipid toxicity by mobilizing fat from fat, muscle, liver and beta cells. Helps to preserve beta cell function. Brand names: Avandia and Actos. Side effects can be serious including exacerbating congestive heart failure or risk of a heart attack in CHF patients.
- Biguanides – decrease manufacture of glucose in the liver (hepatic lipogensis), increases insulin sensitivity. They are often used with TZDs and sulfonylureas. Can be used for pre-diabetes and polycystic ovary syndrome. Brand names: Metformin, Glucophage. Side effects are usually related to gastrointestinal symptoms such as gas, bloating, diarrhea and nausea. These symptoms may be reduced with the newer time release form. Metformin is associated with low B12 levels causing high homocysteine. High levels of homocysteine are related to cardiovascular disease, strokes, dementias, migraines, macular degeneration, neuropathy and osteoporosis.
- SGLP2 inhibitors – decrease blood glucose by increasing the kidney excretion of glucose. Brand names: Jardiance, Farxiga, Invokana. Side effects include dehydration, genital yeast infections, hypotension, hypoglycemia when used with other diabetes medications, increase glucagon and thus increase glucose levels, stress kidney function, bone fractures, cardiovascular events and ketoacidosis in people with type 2. Note that it is rare for people with type 2 to get ketoacidosis. In the case of these drugs the kidney may be unable to handle ketones even if simply due to carbohydrate restriction. Caution is advised in the use of these drugs.
- DPP-IV inhibitors – decrease glucagon, decrease postprandial glucose, enhance insulin secretion. Brand names: Januvia,Onglyza. Side effects include upper respiratory infections, urinary tract infections and recent reports of severe joint pain.
- Non insulin injectables such as incretin mimetics – a GLP 1 agonist. Improve beta cell function, reduce liver glucose production, reduce glucagon secretion, delays stomach emptying and reduce appetite resulting in weight loss. Brand names: Byetta, Victoza. Side effects include hypoglycemia if used with sulfonylureas, pancreatitis, nausea and kidney impairment. Side effects from a recently published study on mice with human beta cell implants using Victoza found deterioration of beta cells with long term use.
- Insulin-There are several types of insulin that can be used alone, with others or along with oral medications. Brand names: Aprida, Novolog and Humalog are rapid acting, duration 3 to 5 hrs. Regular insulin is short-acting, duration up to12 hrs. NPH is intermediate acting; duration is up to 24 hrs. and Lantus and Levemir is long acting, duration up to 24 hrs. Side effects include hypoglycemia, weight gain, lipomas at injection sites, rash, itching, headaches, flu-like symptoms and cardiovascular risks.
Drug Therapy for Diseases Associated with Diabetes
Because most people with type 2 diabetes are overweight or obese they usually suffer from other conditions that are commonly treated with the long term use of medications.
They become a part of the prescribed polypharmacy. Note that lean people can also develop type 2 diabetes and are often prescribed these medications as well.
- ARBs– Angiotensin receptor blockers often prescribed once a diagnosis of diabetes is made to protect kidney function. It can also lower blood pressure.
Brand names: Avapro, Cozaar, Micardis, Diovan. Side effects include hypotension, sexual dysfunction, increased potassium blood levels, renal failure and muscle and bone pain.
- Statins are another class of drugs often prescribed once diabetes is diagnosed. They lower total and LDL cholesterol. The theory has been that it is the presence of high cholesterol in the blood that causes the vascular complications of diabetes. However, stains have an anti-inflammatory effect and this is likely where its limited benefits come from. Interestingly, many people with diabetes have more difficulty managing triglycerides and HDL than LDL. Statins have limited effect on triglycerides and HDL.
Brand names: Lipitor, Torvast, Baycol, Lescol, Mevacor, Pravachol, Crestor and Zocor are the most common. Side effects can be severe and in some people lethal. They include decreased memory, fatigue, decreased exercise tolerance, muscle pain, sleep disruption, weakness, increased diabetes risk, neuropathy symptoms, sexual dysfunction, irritability, depression and weight gain. Statins may increase risks for cancers, autoimmune disease, kidney or liver problems and heart failure. Important nutrients such as coenzyme Q10 and K2 are depleted with statin use. This depletion is suspected in playing a role in increased calcification of blood vessels and heart failure.
- Proton Pump Inhibitors for GERD (gastroesophageal reflux disease). This condition is common in overweight or obese individuals.
Brand names: Prilosec, Acidphex, Prevacid, Protonix and Nexium. Side effects include headache, constipation, diarrhea, abdominal pain, nausea and rash. Long term use can cause osteoporosis, a reduction of B12 absorption, low levels of magnesium, increased risk of C. difficile infection and heart attack. Short term use only is recommended. However, it is not unusual for those of us in clinical practice to see new patients who have taken these drugs for years.
- Anti-hypertensives are common because overweight, obesity and metabolic syndrome are risks for high blood pressure. In addition to ARBs mentioned above there are a number of categories of medications used for hypertension. They are beta-blockers-Brand names: Tenormin, Lopressor. Side effects are numerous including macular degeneration and caution with people with diabetes as they can mask symptoms of hypoglycemia.
Ace inhibitors-Brand names: Vasotec, Altace, Lisinopril. Side effects include low blood pressure, chronic cough.
Calcium channel blockers-Brand names: Verapamil, Cardizem, Norvasc. Side effects include low blood pressure, headaches, rash and edema.
- Diuretics for high blood pressure are often given in conjunction with medications listed above. Brand names: Lasix, Diuril, Lozol, Dyazide, Maxzid. Side effects can include increased blood sugar and depletetion of potassium and /or magnesium causing leg and muscle cramps.
- Anti-depressants are commonly prescribed drugs in the US. People with blood sugar imbalances, especially diabetes, are often depressed and medicated. The most popular drugs are SSRIs. They work by decreasing serotonin blockers in the brain. Brand names: Zoloft, Prozac, Paxil, Celexa. Side effects include sexual dysfunction, weight gain, agitation, insomnia.
Standard Dietary Advice
For decades the American Diabetes Association set the standard of care for people with diabetes. They recommended a diet based on the US Dietary Guidelines, the same diet that was supposed to improve the health and well-being of our population. Surprisingly, The ADA also felt that people with diabetes should be able to consume the same foods as everyone else, even though they are carbohydrate intolerant! Remember, that it is carbohydrates that primarily increase blood sugar levels.
Because of the mistaken fear of dietary fats and protein (see the HEAL article rebutting the concern over cholesterol), a diet high in carbohydrates became the norm. However, we have known for a long time that the many complications that occur with poorly controlled diabetes are due to the damage to large and small blood vessels from high levels of sugar and insulin in the blood. It is no wonder that following the ADA advice has been a disaster, causing most people with diabetes to be poorly controlled even when taking loads of expensive and potentially dangerous medications.
Economics of Standard Therapies
Considering that about 67% of our population already has diabetes, pre-diabetes or asymptomatic obesity, the financial consequences to our country are dire unless we change our approach. We can no longer recommend a diet that includes the very foods that elevate blood sugar and then reply on medications that aren’t a cure and have serious side effects.
Consider the following:
- We are subject to regular increases in drug costs well beyond inflation.
- Older people with diabetes will experience increasing drug costs and can find themselves in the Medicare part D ‘donut hole,’ meaning once the cost to Medicare and your out of pocket expenses reach $2800 you are responsible for all drug costs until you reach $4550, when Medicare will again kick in. Consequently, many people begin to cut their doses of medications, often worsening their condition.
- Pre-diabetes and diabetes already costs the US $322 billion per year.
- One in every five healthcare dollars is spent for diabetes care.
- One in every 3 Medicare dollars is spent for diabetes care.
- A middle-aged adult with diabetes will have a disability 6 to 7 years earlier than one without diabetes.
- A person with diabetes will die 4.6 years earlier and will be sicker in their last years of life.
- The ADA along with most dieticians and diabetes educators still recommend 45 to 60 grams of carbohydrate per meal and 15 to 20 grams of carbohydrate for snacks. This advice continues even though research has shown that carbohydrate restriction gets far better results.
Effectiveness of Standard Therapies
Besides being increasingly unaffordable the reliance on multiple medications to control blood sugar while consuming a high carbohydrate diet simply makes no physiologic sense. Chances of getting blood sugar control low enough to prevent complications are unlikely unless one removes the offending foods.
How many people are meeting treatment guidelines? A 2015 online article on ScienceDaily quoted the ADA guidelines for good diabetes control as having an A1C level of < 7%, blood pressure, < 140/90, and LDL cholesterol of < 100. A large group of people with diabetes were studied using standard therapies including taking some amount of medications. The results were: 72% met the A1C goal, 73% met the BP goal and 63% met the LDL goal. Only 35% met all three goals.
The ADA believes that an A1C less than 7% is good control. An A1C is a blood test that measures the amount of glucose carried in red blood cells. It gives a picture of the blood sugar average over the last 3 months. An A1C of 6.9% translates to an average sugar of 151. We know that blood sugar damage to the kidney and eyes can begin with an A1C in the pre-diabetic range of 5.7 to 6.4%.
Why would anyone settle for a slow progression of damage to the body when one can do better? Why would the ADA continue to recommend 45 to 60 grams of carbohydrates each meal and accept that multiple medications are required to obtain so called “good control”?
The HEAL Protocol – Better Control without medications
Since carbohydrates are the primary driver of blood sugar and insulin secretion, the goal of dietary therapy should be to avoid those foods that increase blood sugar causing the need for ever increasing amounts of insulin. By avoiding stress on the pancreatic beta cells by following a low carbohydrate diet, one decreases the risk of beta cell failure.
Although insulin resistance in liver and muscle cells is already present at the start of pre-diabetes, full blown diabetes would not occur without progression of beta cell failure. It is important to note that beta cell function can already be comprised in a susceptible individual even at high-normal levels of blood sugar.
By keeping insulin levels low one can also decrease fat storage, avoiding fat deposition on the body and in the pancreas thus having a protective effect on beta cells. Preservation of beta cell function and mass is especially important as we age since ageing is a risk factor for type 2 diabetes.
Unlike the standard treatment plan for diabetes, the HEAL Protocol recommends a very low carbohydrate, moderate protein and higher fat diet. By cutting carbohydrates to a 20 gram (total, not net) level daily, blood sugar levels will decrease especially after meals, moderating the need for high insulin production. Because this approach can be so effective, so quickly, it’s necessary to immediately cut diabetes medications, especially insulin and those that stimulate insulin. If medications remain at the same dose the risk of a dangerous low blood sugar reaction is possible. The plan can be so effective that many patients need to stop all insulin immediately on the first day of their plan.
Of course one size does not fit all. The HEAL Protocol is individually adjusted allowing the time it may take some people to correct long standing metabolic abnormalities. These abnormalities are present in people with excessive body fat, pre-diabetes and type 2 diabetes. This is why it is so important to be supervised by a medical practitioner well versed in carbohydrate restriction.
Not Just Improvement in Blood Sugar
Some of the most dramatic results we experience in our patients using the HEAL Protocol are not only limited to improvement in blood sugar levels. Many experience the following:
- Remission of diabetes with the elimination of most or all diabetes related medications.
- Decreased risk of diabetes complications with improved blood sugar and insulin levels.
- Weight loss without hunger and cravings.
- Improved blood pressure resulting in decreased medications and often the eventual removal of these drugs.
- Improvement in triglyceride/HDL ratio decreasing cardiovascular risks.
- Shift into Pattern A lipid profile, which means a shift to predominately large, buoyant LDL particle sizes which are less atherogenic, i.e., not nearly as dangerous to vascular health as small LDL particles.
- Improvement in kidney function as blood sugar levels improve.
- Decreased GERD (gastroesophageal reflux disorder).
- Improvement in energy, moods, sleep, cognitive function, and overall better quality of life.
- Less joint pain, less headaches.
- Stronger immune function making one less prone to infections.
- Restoring depleted nutrient levels by consuming a whole foods diet.
Make the Best Decision for Yourself
You can’t teach an old dog new tricks is an tired excuse. The ADA has slightly softened their stance about low carbohydrate diets but they continue to be financially supported by the drug and food industry whose main priority is to protect profits. Don’t let yourself get caught in this trap because of a thread-bear and tired excuse.
As more research is published demonstrating that a low-carb lifestyle is the most effective health plan for anyone with weight to lose or who have blood sugar challenges, more healthcare practitioners will see the light. Many are unhappy with the current advice they are providing their patients and looking for something that works better. We know the HEAL Low-Carb Protocol works wonders. There is decades of clinical experience and research behind carbohydrate restriction.
While waiting for the health authorities at the top to change, we must aggressively push our grassroots solution by spreading the word on blogs, podcasts and relating our experiences on Facebook and other social media.
Practitioners at HEAL can guide you to correct the underlying reasons for your condition, help you reach truly good blood sugar control, and increase your chances of putting your diabetes in remission. To ensure long term success an important HEAL component is our coaching program to support you while making these important changes.
If you have a family history of diabetes, had gestational diabetes, have PCOS or have difficulty managing weight, HEAL can help you prevent Type 2 diabetes. Prevention is always best and a lot less expensive.
Carbohydrate restriction has made such a difference in many people’s lives. Those of us who have used it personally and professionally know the value it can add to one’s quality of life. It can help you too.